A robotic system to train activities of daily living in a virtual environment

In the past decade, several arm rehabilitation robots have been developed to assist neurological patients during therapy. Early devices were limited in their number of degrees of freedom and range of motion, whereas newer robots such as the ARMin robot can support the entire arm. Often, these devices are combined with virtual environments to integrate motivating game-like scenarios. Several studies have shown a positive effect of game-playing on therapy outcome by increasing motivation. In addition, we assume that practicing highly functional movements can further enhance therapy outcome by facilitating the transfer of motor abilities acquired in therapy to daily life. Therefore, we present a rehabilitation system that enables the training of activities of daily living (ADL) with the support of an assistive robot. Important ADL tasks have been identified and implemented in a virtual environment. A patient-cooperative control strategy with adaptable freedom in timing and space was developed to assist the patient during the task. The technical feasibility and usability of the system was evaluated with seven healthy subjects and three chronic stroke patients.

'Security Here is Not Safe': Violence, Punishment, & Space in the Contemporary U.S. Penitentiary

The US penitentiary at Lewisburg, Pennsylvania, was retrofitted in 2008 to offer the country’s first federal Special Management Unit (SMU) program of its kind. This model SMU is designed for federal inmates from around the country identified as the most intractably troublesome, and features double-celling of inmates in tiny spaces, in 23-hour or 24-hour a day lockdown, requiring them to pass through a two-year program of readjustment. These spatial tactics, and the philosophy of punishment underlying them, contrast with the modern reform ideals upon which the prison was designed and built in 1932. The SMU represents the latest punitive phase in American penology, one that neither simply eliminates men as in the premodern spectacle, nor creates the docile, rehabilitated bodies of the modern panopticon; rather, it is a late-modern structure that produces only fear, terror, violence, and death. This SMU represents the latest of the late-modern prisons, similar to other supermax facilities in the US but offering its own unique system of punishment as well. While the prison exists within the system of American law and jurisprudence, it also manifests features of Agamben’s lawless, camp-like space that emerges during a state of exception, exempt from outside scrutiny with inmate treatment typically beyond the scope of the law.

"Security Here is Not Safe": Violence, Punishment, and Space in the Contemporary US Penitentiary

The US penitentiary at Lewisburg, Pennsylvania, was retrofitted in 2008 to offer the country's first federal Special Management Unit (SMU) program of its kind. This model SMU is designed for federal inmates from around the country identified as the most intractably troublesome, and features double-celling of inmates in tiny spaces, in 23-hour or 24-hour a day lockdown, requiring them to pass through a two-year program of readjustment. These spatial tactics, and the philosophy of punishment underlying them, contrast with the modern reform ideals upon which the prison was designed and built in 1932. The SMU represents the latest punitive phase in American penology, one that neither simply eliminates men as in the premodern spectacle, nor creates the docile, rehabilitated bodies of the modern panopticon; rather, it is a late-modern structure that produces only fear, terror, violence, and death. This SMU represents the latest of the late-modern prisons, similar to other supermax facilities in the US but offering its own unique system of punishment as well. While the prison exists within the system of American law and jurisprudence, it also manifests features of Agamben's lawless, camp-like space that emerges during a state of exception, exempt from outside scrutiny with inmate treatment typically beyond the scope of the law

Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation

The European Society of Cardiology heart failure guidelines firmly recommend regular physical activity and structured exercise training (ET), but this recommendation is still poorly implemented in daily clinical practice outside specialized centres and in the real world of heart failure clinics. In reality, exercise intolerance can be successfully tackled by applying ET. We need to encourage the mindset that breathlessness may be evidence of signalling between the periphery and central haemodynamic performance and regular physical activity may ultimately bring about favourable changes in myocardial function, symptoms, functional capacity, and increased hospitalization-free life span and probably survival. In this position paper, we provide practical advice for the application of exercise in heart failure and how to overcome traditional barriers, based on the current scientific and clinical knowledge supporting the beneficial effect of this intervention.

A self-developed and constructed robot for minimally invasive cochlear implantation

Conclusion: A robot built specifically for stereotactic cochlear implantation provides equal or better accuracy levels together with a better integration into a clinical environment, when compared to existing approaches based on industrial robots. Objectives: To evaluate the technical accuracy of a robotic system developed specifically for lateral skull base surgery in an experimental setup reflecting the intended clinical application. The invasiveness of cochlear electrode implantation procedures may be reduced by replacing the traditional mastoidectomy with a small tunnel slightly larger in diameter than the electrode itself. Methods: The end-to-end accuracy of the robot system and associated image-guided procedure was evaluated on 15 temporal bones of whole head cadaver specimens. The main components of the procedure were as follows: reference screw placement, cone beam CT scan, computer-aided planning, pair-point matching of the surgical plan, robotic drilling of the direct access tunnel, and post-operative cone beam CT scan and accuracy assessment. Results: The mean accuracy at the target point (round window) was 0.56 ± 41 mm with an angular misalignment of 0.88 ± 0.41°. The procedural time of the registration process through the completion of the drilling procedure was 25 ± 11 min. The robot was fully operational in a clinical environment.

Multiple small "imaging" branch-duct type intraductal papillary mucinous neoplasms (IPMNs) in familial pancreatic cancer: indicator for concomitant high grade pancreatic intraepithelial neoplasia?

Most screening programs for familial pancreatic cancer are currently based on endoscopic ultrasonography and/or magnetic resonance imaging (MRI). Cystic lesions, especially those suspicious for small intraductal pancreatic mucinous neoplasms (IPMNs) of the branch ducts, can be visualized in up to 40 % of individuals at risk, but their pathological importance in the setting of FPC is yet not well established. Individuals at risk from a prospective screening program for familial pancreatic cancer with small "imaging" IPMNs of the branch-duct type (BD-IPMN) who underwent pancreatic resection were analysed regarding clinico-pathological data and the locations of pancreatic lesions. Five of 125 individuals at risk who underwent screening had multiple small (size 2-10 mm) unicystic lesions and/or multicystic single lesions in the pancreatic body and tail suspicious for BD-IPMNs upon MRI imaging and decided to undergo surgical resection after interdisciplinary counselling, although none fulfilled the consensus criteria for IPMN resection. Histological examination revealed BD-IPMNs with low or moderate dysplasia of the gastric type in combination with multifocal PanIN2 and PanIN3 lesions in 4 individuals. The remaining patient had only tiny ductectasias in the pancreatic tail with multifocal PanIN 2 lesions in the entire gland and one PanIN3 lesion in the pancreatic head. Intriguingly, the location of the most dysplastic histological lesions (PanIN3) did not correspond to the preoperatively detected lesions and were not visible in preoperative imaging. In the setting of FPC, the presence of multiple small "imaging" BD-IPMNs may indicate the presence of high-grade PanIN lesions elsewhere in the pancreas.

Energy-Economical Heuristically Based Control of Compass Gait Walking on Stochastically Varying Terrain

Investigation uses simulation to explore the inherent tradeoffs ofcontrolling high-speed and highly robust walking robots while minimizing energy consumption. Using a novel controller which optimizes robustness, energy economy, and speed of a simulated robot on rough terrain, the user can adjust their priorities between these three outcome measures and systematically generate a performance curveassessing the tradeoffs associated with these metrics.

DEVELOPMENT OF A HUMANOID ROBOT ARM FOR USE IN URBAN ENVIRONMENTS

The Bucknell Humanoid Robot Arm project was developed in order toprovide a lightweight robotic arm for the IHMC / Bucknell University bipedal robot that will provide a means of manipulation and facilitate operations in urban environments. The resulting fabricated arm described in this thesis weighs only 13 pounds, and is capable of holding 11 pounds fully outstretched, lifting objects such as tools, and it can open doors. It is also capable of being easily integrated with the IHMC / Bucknell University biped. This thesis provides an introduction to robots themselves, discusses the goals of the Bucknell Humanoid Robot Arm project, provides a background on some of the existing robots, and shows how the Bucknell Humanoid Robot Arm fits in with the studies that have been completed. After reading these studies, important items such as design trees and operational scenarios were completed. The completion of these items led to measurable specifications and later the design requirements and specifications. A significant contribution of this thesis to the robotics discipline involves the design of the actuator itself. The arm uses of individual, lightweight, compactly designed actuators to achieve desired capabilities and performance requirements. Many iterations were completed to get to the final design of each actuator. After completing the actuators, the design of the intermediate links and brackets was finalized. Completion of the design led to the development of a complex controls system which used a combination of Clanguage and Java.

Transnational Marriage: Modern Imaginings, Relational Realignments, and Persistent Inequalities

In the context of shifting cultural anchors as well as unstable global economic conditions, new practices of intimacy and sexuality may become tactics in an individual’s negotiation of conflicting desires and potentials. This article offers reflection on the interface between global forces, powerful transcultural narratives, and state policies, on the one hand, and local, even individual, constructions and tactics in regard to sexuality, marriage, migration, and work, on the other. The article focuses on the life trajectory of Gudiya, an ambitious young Hindu woman who started out life with little social capital and few economic resources in a dusty corner of what was then the tiny kingdom of Nepal. Gudiya’s story highlights the ways in which she has engaged in relational realignments aimed at bringing her closer to the life she imagines, even as she has encountered new and persistent forms of inequality both local and transnational in scale.

Homeland security: IgA immunity at the frontiers of the body

IgA is the most abundant immunoglobulin produced in mammals, and is mostly secreted across mucous membranes. At these frontiers, which are constantly assaulted by pathogenic and commensal microbes, IgA provides part of a layered system of immune protection. In this review, we describe how IgA induction occurs through both T-dependent and T-independent mechanisms, and how IgA is generated against the prodigious load of commensal microbes after mucosal dendritic cells (DCs) have sampled a tiny fraction of the microbial consortia in the intestinal lumen. To function in this hostile environment, IgA must be induced behind the 'firewall' of the mesenteric lymph nodes to generate responses that integrate microbial stimuli, rather than the classical prime-boost effects characteristic of systemic immunity.

ANKLE IMPEDANCE AND ANKLE ANGLES DURING STEP TURN AND STRAIGHT WALK: IMPLICATIONS FOR THE DESIGN OF A STEERABLE ANKLE-FOOT PROSTHETIC ROBOT

During locomotion, turning is a common and recurring event which is largely neglected in the current state-of-the-art ankle-foot prostheses, forcing amputees to use different steering mechanisms for turning, compared to non-amputees. A better understanding of the complexities surrounding lower limb prostheses will lead to increased health and well-being of amputees. The aim of this research is to develop a steerable ankle-foot prosthesis that mimics the human ankle mechanical properties. Experiments were developed to estimate the mechanical impedance of the ankle and the ankles angles during straight walk and step turn. Next, this information was used in the design of a prototype, powered steerable ankle-foot prosthesis with two controllable degrees of freedom. One of the possible approaches in design of the prosthetic robots is to use the human joints’ parameters, especially their impedance. A series of experiments were conducted to estimate the stochastic mechanical impedance of the human ankle when muscles were fully relaxed and co-contracting antagonistically. A rehabilitation robot for the ankle, Anklebot, was employed to provide torque perturbations to the ankle. The experiments were performed in two different configurations, one with relaxed muscles, and one with 10% of maximum voluntary contraction (MVC). Surface electromyography (sEMG) was used to monitor muscle activation levels and these sEMG signals were displayed to subjects who attempted to maintain them constant. Time histories of ankle torques and angles in the lateral/medial (LM) directions, inversion-eversion (IE), and dorsiflexionplantarflexion (DP) were recorded. Linear time-invariant transfer functions between the measured torques and angles were estimated providing an estimate of ankle mechanical impedance. High coherence was observed over a frequency range up to 30 Hz. The main effect of muscle activation was to increase the magnitude of ankle mechanical impedance in all degrees of freedom of the ankle. Another experiment compared the three-dimensional angles of the ankle during step turn and straight walking. These angles were measured to be used for developing the control strategy of the ankle-foot prosthesis. An infrared camera system was used to track the trajectories and angles of the foot and leg. The combined phases of heel strike and loading response, mid stance, and terminal stance and pre-swing were determined and used to measure the average angles at each combined phase. The Range of motion (ROM) in IE increased during turning while ML rotation decreased and DP changed the least. During the turning step, ankle displacement in DP started with similar angles to straight walk and progressively showed less plantarflexion. In IE, the ankle showed increased inversion leaning the body toward the inside of the turn. ML rotation initiated with an increased medial rotation during the step turn relative to the straight walk transitioning to increased lateral rotation at the toe off. A prototype ankle-foot prosthesis capable of controlling both DP and IE using a cable driven mechanism was developed and assessed as part of a feasibility study. The design is capable of reproducing the angles required for straight walk and step turn; generates 712N of lifting force in plantarflexion, and shows passive stiffness comparable to a nonload bearing ankle impedance. To evaluate the performance of the ankle-foot prosthesis, a circular treadmill was developed to mimic human gait during steering. Preliminary results show that the device can appropriately simulate human gait with loading and unloading the ankle joint during the gait in circular paths.

Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology

Heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of heart failure patients receive specialist palliative care. Heart failure patients may have generic palliative care needs, such as refractory multifaceted symptoms, communication and decision making issues and the requirement for family support. The Advanced Heart Failure Study Group of the Heart Failure Association of the European Society of Cardiology organized a workshop to address the issue of palliative care in heart failure to increase awareness of the need for palliative care. Additional objectives included improving the accessibility and quality of palliative care for heart failure patients and promoting the development of heart failure-orientated palliative care services across Europe. This document represents a synthesis of the presentations and discussion during the workshop and describes recommendations in the area of delivery of quality care to patients and families, education, treatment coordination, research and policy.

[The patent nasopalatine duct. A rare anomaly and diagnostic pitfall]

The patent nasopalatine duct is a rare anomaly in the anterior maxilla. During the early fetal period, a bilateral and epithelium-lined duct is formed within the primary palatal process as an oro-nasal communication. However, the duct obliterates and degenerates before birth. A persisting patent or through-and-through nasoplatine duct is therefore considered a developmental anomaly. A patent nasopalatine duct normally presents as one (or two) tiny openings lateral or posterior to the incisive papilla. In such a case, the ducts can be partially or completely probed with gutta-percha points with subsequent radiographic imaging. The patients report strange sensations such as squeaking noise, palatal drainage, nasal regurgitation, or airway communication between nasal and oral cavities; however, patients rarely complain about pain. About 40 cases have been documented in the literature. We describe two patients who have been referred to our department for evaluation of "sinus tracts" in the anterior palate. Since a patent nasopalatine duct can become a diagnostic pitfall, a thorough inspection of the mucosa around the incisive papilla is essential to avoid unnecessary endodontic or surgical interventions in the area of the central maxillary incisors.

Generierung von Konstruktionsmerkmalen zur Entwicklung eines bio-inspirierten Kommissionier- Greifers für die Intralogistik mittels Clusteranalyse

Kurzbeschreibung: In der Automatisierung von intralogistischen Kommissioniervorgängen ist ein großes Zukunftspotential erkennbar. Elementarer Bestandteil des Automatisierungsprozesses ist der Einsatz von Industrierobotern, die mit einem geeigneten Endeffektor, dem Greifer, ausgestattet werden müssen. Die Robotik ist in der Lage schneller, präziser und ausdauernder als die menschlichen Kommissionierer zu arbeiten und trägt damit entscheidend zur Effizienzsteigerung bei. Eine wesentliche Herausforderung für diesen Entwicklungsschritt zur Substitution der manuellen Kommissionierung ist die Konstruktion und Bereitstellung eines geeigneten Greifsystems. Am Lehrstuhl für Maschinenelemente und Technische Logistik der Helmut-Schmidt-Universität wurde mit der Erfahrung aus einem vorangegangenen Forschungsprojekt die Methode der Clusteranalyse erstmalig zur Untersuchung von Greifobjekten zur Entwicklung eines bionischen Universalgreifers für die Kommissionierung von Drogerieartikeln verwendet. Diese Abhandlung beschreibt einen Beitrag zur Entwicklung dieses Greifers am Beispiel handelsüblicher Drogerieartikel, die aktuell manuell kommissioniert werden. Diese werden hinsichtlich der für das Greifen relevanten Objektmerkmale geclustert und die daraus resultierenden Erkenntnisse in Form von Konstruktionsmerkmalen abgeleitet. Nach einer Analyse und Festlegung der greifrelevanten Merkmale der Greifobjekte wird eine Objektdatenbasis erstellt. Mit Hilfe geeigneter Methoden wird die gewonnene Datenbasis aufbereitet und reduziert. Im Anschluss werden die Greifobjekte bzw. deren Merkmalsausprägungen einer hierarchischen Clusteranalyse unterzogen. Hierbei werden die Grenzen der gebildeten Cluster mittels der zugehörigen Greifobjekte festgelegt und analysiert. Abschließend werden bestimmte greiferspezifische Merkmale auf die Anwendbarkeit in den Clustern überprüft und bewertet. Diese Betrachtungen ermöglichen es, dass spezielle Anforderungen an den Greifer, die direkt aus den Eigenschaften der Greifobjekte herrühren, zuverlässig erkannt und konstruktiv berücksichtigt werden können.